Map of life expectancy at birth from Global Education Project.

Monday, July 03, 2006

Rigorous Distinctions

A couple of years ago, the National Association to Advance Fat Acceptance held its annual meeting in the Boston area, and they're coming back to Boston this year. NAAFA summarizes the problems its members confront:

An estimated 38 million Americans are significantly heavier than average, and face societal and institutional bias because of their size. Fat people are discriminated against in employment, education, access to public accommodations, and access to adequate medical care. In addition, fat people are stigmatized, and are the victims of tasteless jokes and assaults on their dignity. Despite evidence that 95-98% of diets fail over three years, our thin-obsessed society continues to believe that fat people are at fault for their size.

Of course, more and more people in America are fat (which is what NAAFA members prefer to be called -- euphemisms only serve to suggest that it's shameful). The Boston Globe today reports that this is a new business opportunity -- wider seats, bigger clothes, all to serve a growing market. (Sorry about that.) My doctor's office now has double-wide chairs for those who need them. There are three ladies in my neighborhood who ride the subway to work together, who take up six seats among them. Last night at my local watering hole, some of the regulars were discussing their friend who weighs 450 pounds. They'd had a party and ordered five pizzas, and he ate four of them.

When NAAFA was last in town, two of its leaders appeared on a public affairs show on our PBS station. They were absolutely right that it is unconscionable that fat people endure discrimination, humiliation, and blame. However, they also claimed that there are no health risks associated with extreme overweight. Each of the women weighed well over 300 pounds, and they were adamant that they were in no danger from this condition. They insisted that claims that obesity is bad for you are slanderous lies.

I'm afraid I can't go that far. There is some legitimate disagreement right now about the risk associated with being what is now defined as moderately overweight. But there is absolutely no doubt, not a shred, that severe obesity -- which definitely describes both of them -- places people at high risk for diabetes, heart disease, and early death, as well as osteoarthritis of the lower extremities and other orthopedic problems. It's easy to see why people who have suffered from discrimination and ostracism would want to proclaim that everything is positive about their condition. So the irony (I think that's the right term) is that if fat people were accepted, and the cruel jokes and mistreatment were to end, it would be easier for them to accept the health consequences of obesity -- and in fact, they would probably have more success at managing their weight, if that's what they chose to do, and any health consequences of excessive weight.

The epidemic (if that's what you want to call it) of obesity is a consequence of an environment which is radically different from the one in which our ancestors evolved. It's not the fault of fat people that they are fat. We can certainly think about ways to change the environment to make this problem less common. Meanwhile it's treated as a medical condition, and as is the case with so many of the problems we discuss here, that is often counterproductive. I'll have more to say about that later.

Finally, of course, death is not the worst thing that can happen to us -- which is fortunate indeed or life would be pointless. Nobody lives forever, and if somebody concludes that struggling against fatness is just not worth it to them, there is no reason not to respect that choice.

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